Multiple infections and subsequent cardiovascular events in the Heart Outcomes Prevention Evaluation (HOPE) study

• Published in: Circulation (New York, N.Y.) N.Y.), 2003-01, Vol.107 (2), p.251-257
• Main Authors: SMIEJA, Marek, GNARPE, Judy, LONN, Eva, GNARPE, Hakan, OLSSON, Gunnar, QILONG YI, DZAVIK, Vladimir, MCQUEEN, Matthew, YUSUF, Salim
• Format: Article
• Language: English
• Subjects: Aged; Antibodies, Bacterial - blood; Antibodies, Viral - blood; Biological and medical sciences; Canada - epidemiology; Cardiology. Vascular system; Cardiovascular Diseases - epidemiology; Chlamydophila Infections - blood; Chlamydophila Infections - epidemiology; Chlamydophila Infections - immunology; Chlamydophila pneumoniae - immunology; Comorbidity; Coronary heart disease; Cytomegalovirus - immunology; Cytomegalovirus Infections - blood; Cytomegalovirus Infections - epidemiology; Cytomegalovirus Infections - immunology; Female; Follow-Up Studies; Heart; Helicobacter Infections - blood; Helicobacter Infections - epidemiology; Helicobacter Infections - immunology; Helicobacter pylori - immunology; Hepatitis A - blood; Hepatitis A - epidemiology; Hepatitis A - immunology; Hepatitis A virus - immunology; Humans; Male; Medical sciences; Odds Ratio; Risk Assessment; Seroepidemiologic Studies; Survival Analysis
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.CIR.0000044940.65226.1F

Limited prospective epidemiological data are available on the relation between exposure to Chlamydia pneumoniae, Helicobacter pylori, cytomegalovirus (CMV), and hepatitis A virus (HAV), individually or as a total pathogen score, and human cardiovascular (CV) disease. We analyzed enrollment sera from 3168 Canadian patients in the Heart Outcomes Prevention Evaluation (HOPE) study for antibodies to C pneumoniae, H pylori, CMV, and HAV and measured the relation between serostatus and 494 adjudicated trial outcomes of myocardial infarction, stroke, or CV death over 4.5 years of follow-up. CV events were associated with CMV serostatus (covariate-adjusted hazard ratio [HR], 1.24; 95% CI, 1.01, 1.53). Neither C pneumoniae IgG (adjusted HR, 0.87; 95% CI, 0.68, 1.10), C pneumonia IgA (adjusted HR, 1.10; 95% CI, 0.90, 1.34), H pylori IgG (HR, 0.99; 95% CI, 0.82, 1.19), nor HAV IgG (HR, 1.01; 95% CI, 0.83, 1.24) predicted CV events. Total pathogen score was associated with CV events (adjusted HR for 4 versus 1 or 0=1.41; 95% CI, 1.02, 1.96). Exposure to CMV but not to C pneumoniae, H pylori, or HAV was associated with a slight excess risk of subsequent myocardial infarction, stroke, or CV death in HOPE study patients, and total pathogen score based on these infections predicted a small increased hazard of CV events.